International Journal of Medical Informatics
International Journal of Medical Informatics via MedWorm.com
- Editorial Board
(Source: International Journal of Medical Informatics) - Lessons learned after a three-year store and forward teledermatology experience using internet: Strengths and limitations
Conclusions: A high degree of diagnostic accuracy both for pediatric and adult consultations was achieved using the teledermatology system with affordable technical requirements. Its usefulness for filtering dermatological referrals was also demonstrated in the study. Nevertheless, other factors such as the reorganization required for the physicians’ time schedule, remuneration issues, absence of EHR (electronic health record) integration and lack of interaction with the HCO were important limiting factors. This led to the conclusion that under the evaluation conditions long-term set-up was not possible. It was also concluded that HCO participation would have been essential for both the evaluation study and the long-term set-up of the system. (Source: International Journal of Medical Inf... - Editorial Board
(Source: International Journal of Medical Informatics) - Implementation of an automated system for monitoring adherence to hemodialysis treatment: A report of seven years of experience
Conclusions: EMOSTAT provides an effective way to re-focus the attention of the dialysis department on the treatment plan and on its implementation. The automatic data collection and the design philosophy of EMOSTAT allowed the routine use of the system. (Source: International Journal of Medical Informatics) - Implementation and expansion of an electronic medical record for HIV care and treatment in Haiti: An assessment of system use and the impact of large-scale disruptions
Conclusion: There is real potential for EMRs in developing countries to improve clinical practice and make data available for efficient reporting, quality improvement and other population health uses. An approach of continuous system improvement, combined with regular assessments of use, is necessary for achieving an effective, national implementation of a standardized EMR. We have achieved successes in terms of rolling out new functionality and expanding to new sites, but more work remains to be done to improve perceptions of data quality and increase use of population data for accurate and timely reporting. (Source: International Journal of Medical Informatics) - Internet based patient pathway as an educational tool for breast cancer patients
Conclusions: Patients evaluated the quality of the BCPP to be best in language and structure and weakest in content. In terms of future development of the BCPP, the most improvement is needed in content and instructiveness. There is also a need for further development and study of Internet-based patient education. (Source: International Journal of Medical Informatics) - Reviewing the impact of computerized provider order entry on clinical outcomes: The quality of systematic reviews
Conclusions: The quality of these reviews were moderate. Only one study conducted a full quantitative synthesis, and overall heterogeneity was reported as very high in the 3 studies that measured it. Recommendations emphasize clarifying the phenomenon of CPOE by avoiding reporting conclusions across sub-group analyses, increasing emphasis on the development of theoretical models, including more quantitative assessments, and increasing breadth of outcomes. (Source: International Journal of Medical Informatics) - Editorial Board
(Source: International Journal of Medical Informatics) - Perspectives of Australian adults about protecting the privacy of their health information in statistical databases
Conclusions: Participants believe they should be asked for permission before their health information is used for any purpose other than medical treatment. However, consent and privacy concerns are not necessary related.Assuring individuals that their personal health information is de-identified reduces their concern about the necessity of consent for releasing health information for research purposes, but many people are not aware that removing their names and other direct identifiers from medical records does not guarantee full privacy protection for their health information. Privacy concerns decrease as extra security measures are introduced to protect privacy. Therefore, instead of“tailoring concern” as proposed by Willison we suggest improving privacy protection of personal infor... - Effects of a short text message reminder system on emergency department length of stay
Highlights:► We designed SMS automatic transmission system linked to consultation order. ► The CPOE-based SMS project reduced LOS of consulted patients in the ED. ► This intervention facilitated the decision-making process of consulting physicians.Abstract: Purpose: Specialty consultations and waiting for admission to a hospital bed are major contributors to increased length of stay and overcrowding in the emergency department. We implemented a computerized short messaging service to inform care providers of patient delay in order to reduce length of stay. The purpose of this study was to evaluatethe effects of this strategy on length of stay in the emergency department.Methods: This was a before-and-after observational study. Prior to this study, we registered the mobile phone num... - Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages
Conclusion: SMS messaging can help Brazilian women living with HIV/AIDS to adhere to antiretroviral therapy for a period of at least 4 months. In general, the results are encouraging because the SMS messages stimulated more participants in the intervention group to be adherent to their treatment, and the patients were satisfied with the messages received, which were seen as reminders, incentives and signs of affection by the health clinic for a marginalized population. (Source: International Journal of Medical Informatics) - Prescribers’ interactions with medication alerts at the point of prescribing: A multi-method, in situ investigation of the human–computer interaction
Conclusions: This empiric study produced a novel framework for understanding the prescriber–alert interaction. Results revealed key components of the alert interface that influence prescribers and indicate a need for more universal design. Actionable design recommendations are presented and may be used to enhance alert design and patient safety. (Source: International Journal of MedicalInformatics) - Record completeness and data concordance in an anesthesia information management system using context-sensitive mandatory data-entry fields
Conclusions: Using context-sensitive mandatory fields in an anesthesia information management system was associated with high record completeness rate and data concordance. In addition, the system's usability was rated as very good by its users. (Source: International Journal of Medical Informatics) - Editorial Board
(Source: International Journal of Medical Informatics) - Detection of infectious symptoms from VA emergency department and primary care clinical documentation
Conclusion: This work demonstrates how processed text could enable detection of non-specific symptom clusters for use in automated surveillance activities. (Source: International Journal of Medical Informatics) - Qualitative and quantitative evaluation of EHR-integrated mobile patient questionnaires regarding usability and cost-efficiency
Conclusion: The mobile patient questionnaires, integrated into the electronic health record, were well accepted in our pilot setting with high usability scores from patients and medical staff alike. The system has also proved to be cost-efficient compared to the paper-based workflow, given that a certain number of questionnaires is used per year. (Source: International Journal of Medical Informatics) - Prospective pilot study of a tablet computer in an Emergency Department
Highlights:► Using a tablet computer can decrease time spent at a computer. ► Clinician's felt the tablet was easy to disinfect. ► Clinician expectations cannot be met by a change in form factor alone.Abstract: Background: The recent availability of low-cost tablet computers can facilitate bedside information retrieval by clinicians.Objective: To evaluate the effect of physician tablet use in the Emergency Department.Design: Prospective cohort study comparing physician workstation usage with and without a tablet.Setting: 55,000 visits/year Level 1 Emergency Department at a tertiary academic teaching hospital.Participants: 13 emergency physicians (7 Attendings, 4 EM3s, and 2 EM1s) worked a total of 168 scheduled shifts (130 without and 38 with tablets) during the study period.Interve... - Implementation of computerized provider order entry in a neonatal intensive care unit: Impact on admission workflow
Highlights:► Introduction of CPOE improved pharmacy turnaround times. ► Despite improved pharmacy turnaround, there was no change in the time to the first dose of antibiotics. ► Admission workflow is a complex process, and will require a multifaceted approach in order to further improve antibiotic administration time in the neonatal intensive care unit.Abstract: Objective: The study objective was to determine if computerized provider order entry (CPOE) systems impaired or enhanced workflow in the neonatal intensive care unit (NICU) by comparing the timing of administration of the first dose of antibiotics before and after CPOE system implementation.Methods: We conducted a pre-post intervention comparative study of the length of time between admission and administration of initial an... - The effects of EMR deployment on doctors’ work practices: A qualitative study in the emergency department of a teaching hospital
Discussion: We suggest three guidelines for designing future EMR systems to be used in teaching hospitals. First, the design of documentation tools in EMR needs to take into account what we called“note-intensive tasks” to support the collaborative nature of medical work. Second, it should clearly define roles and responsibilities. Lastly, the system should provide a balance between flexibility and interruption to better manage the complex nature of medical work and to facilitate necessary interactions among ED staff and patients in the work environment. (Source: International Journal of Medical Informatics) - Structured electronic operative reporting: Comparison with dictation in kidney cancer surgery
Highlights:► First study operative report quality in kidney cancer surgery. ► First system evaluated that: (i) uses real time POC documentation embedded in the EPR; (ii) uses data fields that are searchable for research and quality assessment. ► Documentation with structured electronic templates improvesquality of OR note.Abstract: Purpose: The purpose of this study was to evaluate the functionality of eKidney as a structured reporting tool in operative note generation. To do this, we compared completeness and timeliness of eKidney template-generated nephrectomy OR notes with standard narrative dictation.Methods: A group of academic uro-oncologists and medical informaticians at the University Health Network designed and adopted an electronic online, point-of-care clinical documenta... - Adoption of electronic health records in Korean tertiary teaching and general hospitals
This study examined the current prevalence of electronic health records (EHRs) in Korea and identified the factors that impede or facilitate the adoption of EHRs.Methods: We surveyed all tertiary teaching and general hospitals in Korea. The degree to which EHR systems were adopted was evaluated using the previously defined definitions of‘comprehensive’ and ‘basic’ EHRs based on their electronic functionality. The effects of teaching status, size, and location of hospitals on EHR adoption were examined. We also investigated factors that impeded or facilitated the adoption of EHR systems.Results: The response rate was 39.0% (122/313), and 37.2% (95% confidence interval [CI] 31.9–42.6%) of Korean tertiary teaching and general hospitals had either basic or comprehensive EHR systems ... - Evaluating the use of a computerized clinical decision support system for asthma by pediatric pulmonologists
Conclusions: Pediatric pulmonologists demonstrated low use of a computerized decision support system for asthma care because of a combination of general and subspecialist-specific factors.Subspecialist-specific factors should not be underestimated when designing guideline-based, computerized decision support systems for the subspecialty setting. (Source: International Journal of Medical Informatics) - Healthcare professionals’ adoption and use of a clinical information system (CIS) in primary care: Insights from the Da Vinci study
Conclusions: A better understanding of the dynamics of CIS implementation provides insight into how best to encourage clinicians to adopt and make full use of such systems to improve the quality of care for multimorbid patients followed in PC settings. (Source: International Journal of Medical Informatics) - Faxed Arabic prescriptions: A medication error waiting to happen?
Conclusions: Prescriptions that are faxed in languages that use diacritical marks to denote contextual meaning, are at high risk for misreading when reproduced via fax. We suggest mitigating strategies, including minimal font size and use of alliteration text in other languages. (Source: International Journal of Medical Informatics) - Electronic decision protocols for ART patient triaging to expand access to HIV treatment in South Africa: A cross sectional study for development and validation
Conclusions: The final screening protocol is highly sensitive and could reduce burden on ART clinicians by 30%. The uptake and acceptance of the handheld tool to support implementation of the protocol was high. Further examination of the data reveals several important questions to include in future referral algorithms to improve sensitivity and specificity. Based on these results, we identify a refined algorithm to explore in future evaluations. (Source: International Journal of Medical Informatics) - Editorial Board
(Source: International Journal of Medical Informatics) - Methodologies for assessing telemedicine: A systematic review of reviews
Conclusions: Larger and more rigorous studies are crucial for the production of evidence of effectiveness of unambiguous telemedicine services for pre defined outcome measures. Summative methodologies acknowledging telemedicine as complex innovations and outcomes as partly contingent on values, meanings and contexts are also important. So are formative, naturalistic methodologies that acknowledge telemedicine as ongoing collaborative achievements and engage with stakeholders, including patients to produce and conceptualise new and effective telemedicine innovations. (Source: International Journal of Medical Informatics) - Preparing the ground for the‘paperless hospital’: A case study of medical records management in a UK outpatient services department
Conclusions: Our findings provide further evidence that there is a need to treat the implementation of EPRs not simply as an exercise in technical system delivery, but as a larger process of sociotechnical systems change. We conclude the paper with some guidelines, the aim of which is to provide guidance regarding EPRs implementation and adoption informed by sociotechnical principles and ideas. (Source: International Journal of Medical Informatics) - Internet skill-related problems in accessing online health information
Conclusions: The amount of online health-related information and services is consistently growing; however, it appears that the general population experiences many skill-related problems, particularly those related to information and strategic Internet skills, and they become very important when it comes to health. These skills are also problematic for younger generations who are often seen as skilled Internet users. The results of the study call for policies that account for low levels of Internet skills. (Source: International Journal of Medical Informatics) - Call for papers: Human factors and the implementation of Health Information Technology (HIT): Comparing approaches across nations
(Source: International Journal of Medical Informatics) - Editorial
Chronic conditions (such as heart disease and stroke) have become the chief causes of death globally. The World Health Organization predicts that by 2030, three-quarters of all deaths in the world will be due to such chronic non-communicable diseases. Over 70% of cardiovascular disease deaths and around 50% of all chronic disease deaths are attributable to a small number of risk factors, which include: unhealthy diet, physical inactivity, tobacco use and high blood pressure. Globally, these factors are increasing as people switch to foods high in fats, salt and sugars, while their work and living situations make them much less physically active. Over 1.6 billion adults worldwide are overweight and it is projected that by 2015, the number could reach 2.3 billion. Tobacco use is also increas... - Smart pump alerts: All that glitters is not gold
Conclusion: It is difficult to obtain accurate data on the true impact of this technology in the early stages of its implementation. This preliminary analysis allowed us to identify improvement measures to distinguish, in future evaluations, the alarms triggered by a real programming error from those caused by incorrect use. (Source: International Journal of Medical Informatics) - Do hospital physicians’ attitudes change during PACS implementation? A cross-sectional acceptance study
Conclusions: In this setting, the main motivation for physicians to start using PACS is effort expectancy, whereas performance expectancy only becomes important after the physicians started using PACS. It is also very important that physicians perceive that their social environment encourages the use of PACS. (Source: International Journal of Medical Informatics) - Effects of two different levels of computerized decision support on blood glucose regulation in critically ill patients
Conclusion: Adherence to protocol sampling rules increased by using decision support with a larger effect at the patient specific level. This led to a decrease in the percentage of hypoglycemia events and improved safety. The use of the CDSS at both levels, however, did not improve the quality of glucose control as measured by our indicators. More research is needed to investigate whether other socio-technical factors are in play. (Source: International Journal of Medical Informatics) - Understanding physicians’ acceptance of the Medline system for practicing evidence-based medicine: A decomposed TPB model
Conclusions: The results of this study indicate that our research model provides an effective prediction of the intention of physicians to use the Medline system and provides valuable implications for academics and practitioners. (Source: International Journal of Medical Informatics) - A usability evaluation of a SNOMED CT based compositional interface terminology for intensive care
Conclusions: This study provides a detailed insight into how clinicians interact with a controlled compositional terminology through a terminology application. The extensiveness, complexity of the hierarchy, and the language usage of an interface terminology are defining for its usability. Carefully crafted domain-specific subsets and a well-designed terminology application are needed to facilitate the use of a complex compositional interface terminology based on SNOMED CT. (Source: International Journal of Medical Informatics) - The use of tags and tag clouds to discern credible content in online health message forums
Conclusion: Many participants in this study focused on assessing whether the information was relevant to their current circumstances, after which they would proceed to determine its credibility by corroborating with other sources. The use of structured tags to label information may not be a useful way to encourage the use of tagging, or to indicate credibility in this context. Current applications used in the semantic web automate this process. Therefore it may be useful to engage consumers of online content, in particular health-related content, to be more directly involved in the annotation of this content. (Source: International Journal of Medical Informatics) - Promoting public awareness of the links between lifestyle and cancer: A controlled study of the usability of health information leaflets
Conclusions: Design guidelines for health information leaflets need to focus on their usability (particularly attractiveness and effectiveness) as well as their legibility and comprehensibility. The attractiveness and effectiveness can be measured using simple usability surveys and awareness tests. (Source: International Journal of Medical Informatics) - ---
In the preface of the book the editor starts with expressing the hope that this book is not yet another textbook on biomedical image processing. Instead the authors want to provide a‘suitable’ textbook on image processing (with suitable defined as ‘comprehensive but short, up-to-date but essential and detailed but illustrative’) that covers all of the special needs in biology and medicine. The contents of the book are based on a tutorial regularly offered at the International SPIE Symposium on Medical Imaging. (Source: International Journal of Medical Informatics) - A novel method for inferring RFID tag reader recordings into clinical events
Conclusion: The results of the study indicated that proximity sensing of the RFID detects proximity events effectively, and the CHIM can infer proximity events accurately. RFID technology can be used for recording complete clinical contact history between caregivers and patients thus assisting in tracing cause of NIs. Since this model could infer the ICU activities accurately, we are convinced that the CHIM can also be applied in other wards and can be used for additional purposes. (Source: International Journal of Medical Informatics) - Barriers and facilitators to the use of computer-based intensive insulin therapy
Conclusion: This analysis revealed sociotechnical interactions affecting IIT CDSS that previous studies have not addressed. These issues may influence protocol performance at other institutions. Findings have implications for IIT CDSS user interface design and alerts, and may contribute to nascent general CDSS theory. (Source: International Journal of Medical Informatics) - Key IT management issues in hospitals: Results of a Delphi study in Canada
Conclusions: This study is the first to systematically and rigorously identify and prioritize critical IT management issues in hospitals, which may be generalizable to similar environments in other industrialized countries. The prioritized lists of IT management issues may be used as a benchmark and diagnostic tool to support internal strategic decision making related to IT. The broadening of understanding of the challenges faced by IT executives in hospitals would support a more systematic evaluation of these issues over time, and allow management, educational, and research resources to be invested in the appropriate areas. (Source: International Journal of Medical Informatics) - The implementation of electronic health records: A case study of bush computing the Ngaanyatjarra Lands
Conclusions: Complex systemic problems often derail ICT projects. The case study of an isolated region provides a number of lessons and insights to improve electronic records adoption projects. The limited resources and limited choices faced by the region lead to the development of a number of key approaches that revolved around aiming for a workable system rather than a high-end flawless solution. This ethos pervaded the electronic health records project and was underpinned by a patient centred approach and a strong desire to improve the service given to patients. (Source: International Journal of Medical Informatics) - Mobile health IT: The effect of user interface and form factor on doctor–patient communication
Conclusion: When information is needed and has to be located at the point-of-care, the user interface and the physical form factor of the mobile information device are influential elements for successful collaboration between doctors and patients. Both elements need to be carefully designed so that physicians can use the devices to support face-to-face dialogue, nonverbal communication, and action visibility. The ability to facilitate and support the doctor–patient collaboration is a noteworthy usability factor in the design of mobile EPR systems. The paper also presents possible design guidelines for mobile point-of-care systems for improved doctor–patient communication. (Source: International Journal of Medical Informatics) - Healthcare professionals’ organisational barriers to health information technologies—A literature review
Conclusions: Despite their apparent promise, health information technologies (HIT) have proved difficult to implement. This systematic review reveals the implementation barriers associated to organisational management and their interrelations. Several important future directions in the field are also suggested: (1) there is a need for further research providing evidence of HIT cost-effectiveness as well as the development of optimal HIT applications; (2) more information is needed regarding organisational change, incentives, liability issues, end-users HIT competences and skills, structure and work process issues involved in realising the benefits from HIT.Future policy interventions should consider the five dimensions identified when addressing the impact of HIT in healthcare organisation... - Designing for healthy living: Supporting reflectivity on interactions in healthcare
We present the mechanics of the development of a visual language and analysis system enabling visual reasoning about the quality of interactions. The visual knowledge representation is designed based on aspects of human movement. Such design is justified from the fact that human possess implicit knowledge about human movement. The paper presents KIA (Kinetic Inter-Acting) encoding system that is the foundation of the visual language and respective visual analysis method. KIA enables both humans and machines to utilise information about how interactions unfold, which is necessary for practitioner–patient interaction. The paper concludes with discussion of KIA approach and technology in terms of the implications for designing for healthy living. (Source: International Journal of Medical In... - An evolutionary-fuzzy DSS for assessing health status in multiple sclerosis disease
Abstract: Assisted Living provides a long-term care option that combines supportive systems and services for monitoring and assessing the health status with activities of daily living and health care. Daily monitoring of the health status in subjects characterized by chronic and/or degenerative conditions is not possible in all those cases where the disease progression has to be evaluated only by a direct interaction between the patients and the healthcare structures on a regular basis, over time and for life. In this respect, this work proposes an evolutionary-fuzzy decision support system (DSS) for assessing the health status of subjects affected by multiple sclerosis (MS) during the disease progression over time. Such a DSS has been defined and implemented exploiting a novel approach de... - Designing personal exercise monitoring employing multiple modes of delivery: Implications from a qualitative study on heart rate monitoring
Conclusions: This study explains several benefits and limitations in personal exercise monitoring. These can be addressed with crossmedial design, i.e., strategic distribution of functionality and content across modes within the system. Our findings suggest that personal exercise monitoring systems may be improved by more systematically combining mobile and web-based functionality. (Source: International Journal of Medical Informatics) - Do integrated record systems lead to integrated services? An observational study of a multi-professional system in a diabetes service
Conclusions: The findings offer suggestive evidence that a shared electronic health record can support more integrated care. Unresolved issues in implementing the system across all services and settings highlight the governance problems that can arise when systems are developed locally but are then extended across organisational and professional boundaries. (Source: International Journal of Medical Informatics) - Physicians’ experiences of participation in healthcare IT development in Finland: Willing but not able
Conclusions: Major improvements are needed both in the usability of the systems currently in use in Finland and in the collaboration between end-users and developers. Improved methods of participation need to be developed and applied, particularly for the procurement, deployment and on-going development of commercial-off-the-shelf applications. (Source: International Journal of Medical Informatics) - A study on Singaporean women's acceptance of using mobile phones to seek health information
Conclusion: This study contributes to the existing literature by applying the Technology Acceptance Model (TAM) in the context of mobile health information seeking, for which there has been a lack of studies, and demonstrated that the inclusion of additional variables can enhance TAM's predictive power. The empirical presence of an intention–behaviour gap calls for future research to investigate the reasons behind the gap. Finally, the findings from this study can serve as input to promote women's use of mobile phones for better self-management of health. (Source: International Journal of Medical Informatics) - Does the introduction of an electronic nursing documentation system in a nursing home reduce time on documentation for the nursing staff?
Conclusion: Introduction of an electronic nursing documentation system did not reduce the proportion of time nursing staff spent on documentation. This may in part have been a result of the practice of documenting some information items on paper and others on a computer. To reduce the use of paper documentation or to achieve a paper-free documentation environment in this setting, an in-depth understanding of nursing staff's information needs, and documentation workflow is necessary. (Source: International Journal of Medical Informatics) - Closing information gaps with shared electronic patient summaries––How much will it matter?
Conclusion: Overall, information about medications and previous history was described in most referrals, but was still the information most frequently inquired or searched for. Qualitative assessments revealed that insufficient information put a significant stress on both patients and staff, and in turn caused additional workload and risky work-arounds. In our assessment, these information deficits could be effectively mitigated by an up to date easy-access patient summary. (Source: International Journal of Medical Informatics) - Engagement in“My Child's Asthma”, an interactive web-based pediatric asthma management intervention
In this study we sought to determine the characteristics of parents who engage in an Internet-based health intervention for their children (with asthma) and to distinguish parents who engage at the prescribed intervals versus those who engage less often.Methods: N=283 parents with children who had asthma were recruited and randomized to receive a web-based intervention. Participants filled out six surveys over a 6-month period asking them about demographic and clinical characteristics, outcome expectations and self-efficacy beliefs regarding asthma control for their child, and attitudes about computers and the Internet. Descriptive statistics were used to describe the population and analyze associations.Results: Controller use and being adherent to this medication as well as positive outco... - Theorizing the health service usage behavior of family caregivers: A qualitative study of an internet-based intervention
Conclusions: This study reinforced the findings of the larger quantitative study that it is important to address both care-giving needs and technology factors in Internet-based intervention. The quantitative study found that less competent caregivers with more positive attitudes towards technology tended to use the intervention more frequently. In this qualitative research, the findings revealed that caregiver needs, ICT factors, and style of use explained the pattern of intervention use. This new conceptualization has integrated information acceptance, health service utilization, and information behavior theories. More studies will be needed to confirm if the proposed concept can explain or predict the usage behavior in other Web-based interventions. (Source: International Journal of Medi... - The importance of the verbal shift handover report: A multi-site case study
Conclusions: The benefits provided by a face to face handover suggest that technology should focus on supporting rather than replacing the verbal shift handover report, providing a flexible solution that allows handover participants to gather more information as it is required. (Source: International Journal of Medical Informatics) - Special Issue Call for Papers: Special Issue on HIV Care Systems Design and Outcomes
(Source: International Journal of Medical Informatics) - Provider acceptance, safety, and effectiveness of a computer-based decision tool for colonoscopy preparation
Highlights:► A decision tool that scans the electronic medical record can identify patients who may safely use sodium phosphate. ► The decision tool was never overruled by endoscopists for clinical reasons. ► Use of the decision tool tended toward better quality preparation and patient satisfaction.Abstract: Purpose: To assess provider acceptance of recommendations by a decision tool that scans the electronic medical record and determines whether sodium phosphate may be taken. In addition, to determine decision tool effects on a composite outcome of colonoscopies canceled, rescheduled, aborted, orrepeated sooner than recommended due to preparation (prep) quality; prep quality; colonoscopy duration; and patient satisfaction with and tolerance of the preparation.Methods: We used 4 al... - Icon and user interface design for emergency medical information systems: A case study
Highlights:► Task analysis of an emergency medical service. ► Emergency personnel participated in the icon design for the medical information system. ► Understandability of the developed icons were tested by a second group of physicians and nurses. ► Final user interface was decided and installed afterassessing two prototypes.Abstract: A usable medical information system should allow for reliable and accurate interaction between users and the system in emergencies. A participatory design approach was used to develop a medical information system in two Turkish hospitals. The process consisted oftask and user analysis, an icon design survey, initial icon design, final icon design and evaluation, and installation of the iconic medical information system with the icons. We observed ... - Guideline for good evaluation practice in health informatics (GEP-HI)
Conclusion: A comprehensive list of issues is presented as a guideline for good evaluation practice in health informatics (GEP-HI). The strengths and weaknesses of the guideline are discussed. Application of this guideline will support better handling of an evaluation study, potentially leading to a higher quality of evaluation studies. This guideline is an important step towards building stronger evidence and thus to progress towards evidence-based health informatics. (Source: International Journal of Medical Informatics) - Artificial intelligence techniques applied to the development of a decision–support system for diagnosing celiac disease
Highlights:► We developed a clinical decision support system (CDSS) for celiac disease diagnosing. ► The attributes relating to signs/symptoms/high-risk groups tested were effective. ► Artificial intelligence techniques were tested to recognize celiac disease cases. ► Bayesian classifier algorithm withwrapper approach had the best performance. ► CDSS achieved high accuracy and good level of agreement compared to gold standard.Abstract: Background: Celiac disease (CD) is a difficult-to-diagnose condition because of its multiple clinical presentations and symptoms shared with other diseases. Gold-standard diagnostic confirmation of suspected CD is achieved by biopsying the small intestine.Objective: To develop a clinical decision–support system (CDSS) integrated with an automat... - Online health information seeking by people with physical disabilities due to neurological conditions
Conclusion: Neurologically disabled people's online health information seeking and use can be predicted by their cognitive perceptions. A heightened disability level increases an individual's online health information seeking, but is not related to the use of such information. Moreover, seeking more online health information does not make an individual use more such information, suggesting that these two behaviors should be carefully differentiated. (Source: International Journal of Medical Informatics) - Bridging two translation gaps: A new informatics research agenda for telemonitoring of chronic disease
Conclusion: Attempts to use telemonitoring to improve the care of patients with chronic diseases over the last two decades have so far failed to lead to systems that are embedded in routine clinical practice. Attempts at implementation have paid insufficient attention to understanding patient and clinical needs and the complex dynamics and accountabilities that arise at the level of service models. A suggested way ahead is to co-design technology and services collaboratively with all stakeholders. (Source: International Journal of Medical Informatics) - Using Cognitive Work Analysis to fit decision support tools to nurse managers’ work flow
Highlights:► Described environmental constraints on nurse managers’ ability to improve safety and quality outcomes through a Cognitive Work Analysis methodology. ► Highlighted nurse managers’ need for decision support tools that can help them plan innovations to improve outcomes in an increasingly complex environment. ► Identified important design constraints that must be considered in developing decision support tools for nurse managers.Abstract: Purpose: To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collab... - Special Issue Call for Papers: Infrastructures in Healthcare: Global Health
(Source: International Journal of Medical Informatics) - National questionnaire study on clinical ICT systems proofs: Physicians suffer from poor usability
Conclusions: The described study and related results are unique in several ways. A national usability study with nearly 4000 respondents had not been conducted in other countries in which healthcare technologies are widely adopted. The questionnaire study provided a generalized picture about the usability problems, however, it should be noted that there were significant differences between legacy systems in use. Previously, researchers had not approached contextual aspects of usability the context of clinical work, where numerous systems are in use. The described usability dimensions and the presented study results can be considered as the first step towards conceptualizing ICT usability in the unique setting of clinical work. (Source: International Journal of Medical Informatics) - A logic programming approach to medical errors in imaging
Highlights:► We extended the Eindhoven Classification Model to the medical imaging field. ► We used the model to classify adverse events root causes. ► We used Extended Logic Programming for knowledge representation. ► We developed an adverse event reporting and learning system. ► The majority of occurrences were concentrated in a few events that could be avoided.Abstract: Background: In 2000, the Institute of Medicine reported disturbing numbers on the scope it covers and the impact of medical error in the process of health delivery. Nevertheless, a solution to this problem may lie on the adoption of adverse event reporting and learning systems that can help to identify hazards and risks. It is crucial to apply models to identify the adverse events root causes, enhance the shar... - Flexibility in interaction: Sociotechnical design of an operating room scheduler
Conclusions: Situated computing can present a number of design challenges that may not be easy for designers and hospital workers to understand before a system has been implemented. Situated computing development may thus need to be aided by PD that includes both ethnographic observations and iterative redesign of the system after it has been implemented. Traditional data validation mechanisms may create poor system performance in cases where users are rushed to input data into the computer due to pressures created by other more critical work activities. In this case it may be better to rely on social mechanisms for correcting errors later on, rather than error catching mechanisms that reject incorrect data. It can be challenging, however, to maintain such systems over time, as IT-departme... - Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly
Conclusion: CDSSs used by RNs and NAs in nursing homes are still largely unexplored. A CDSS can be incorporated into the EHR to increase the meaningful use of these computerized systems in nursing home care. The effects of CDSS on healthcare provider workflow, clinical decision making and communication about preventive measures in nursing home practice still need further exploration. Based on results from our study, recommendations would be to increase both sample size and the number of RNs and NAs who participate in CDSS education programs. (Source: International Journal of Medical Informatics) - Planning and tracking chemotherapy production for cancer treatment: A performing and integrated solution
Conclusions: This intuitive system guarantees a traceability in connection with a high quality system certified ISO 9001-v2000 (with a rapid data entry), an assistant to schedule the production of preparations in a better way, a permanent follow-up and analysis of operations. This project proves the benefits of implementing computer solutions for the traceability and assistance in decision making in the hospital systems. (Source: International Journal of Medical Informatics) - A review of ECG storage formats
Conclusion: It can be concluded that there is a wide range of vastly different techniques used to store the ECG. Although the specifications of these formats are openly available, neither has been internationally adopted to be used with all ECG machines. Therefore, there remains a lack of global interoperability of ECG information. (Source: International Journal of Medical Informatics) - Reporting systems, reporting rates and completeness of data reported from primary healthcare to a Swedish quality register– The National Diabetes Register
Highlights:► It is shown that Swedish primary healthcare centres in general reported data to the National Diabetes Register (NDR) using a web-based system. ► Direct transmission system increased the number of patients reported to the NDR. ► Using a web-based system contributed to higher completeness of data than using direct transmission.Abstract: Objective: The aims of this paper were to study the reporting rate and completeness of data reported from primary healthcare centres (PHCCs) in Sweden to the Swedish National Diabetes Register (NDR), with a special attention on the relation between thesemeasures and the reporting system used by the PHCCs.Method: A national survey conducted in Swedish primary healthcare covering the year 2006. A questionnaire was used to collect data from ... - What do physicians tell laboratories when requesting tests? A multi-method examination of information supplied to the Microbiology laboratory before and after the introduction of electronic ordering
Highlights:► The provision of relevant clinical information is important in facilitating appropriate laboratory test utilization and accurate results interpretation and reporting. ► CPOE was associated with an increase in the quantity and usefulness of clinical information provided to the Microbiology Department of the pathology service. This positive finding is related to the capacity of CPOE systems to provide an integrated platform to access and exchange patient-related information, and prompt physicians to supply valuable information to the laboratories. ► These results have implications for the efficiency and effectiveness of the pathology laboratory contribution to the quality and safety of patient care.Abstract: Background: The provision of relevant clinical information on pa... - Electronic emergency-department whiteboards: A study of clinicians’ expectations and experiences
Conclusion: The ED clinicians experience positive effects of electronic over dry-erase whiteboards. However, their assessment of electronic whiteboards depends on their staff group, evolves over time, and differs from that of paediatric clinicians. These results likely affect clinicians’ acceptance of electronic whiteboards and their command of their work. (Source: International Journal of Medical Informatics) - Social care informatics as an essential part of holistic health care: A call for action
Conclusion: The Exploratory Workshop resulted in a unanimous Declaration for action, which is presented appended to this paper. (Source: International Journal of Medical Informatics) - Publisher note to: Leadership Structures in Emergency Care Settings: A Study of Two Trauma Centers
(Source: International Journal of Medical Informatics) - Analysis and evaluation of the Electronic Health Record standard in China: A comparison with the American national standard ASTM E 1384
Conclusions: Further development of the Chinese EHR Standard should focus on supporting privacy and security mechanism, diverse data types, more generic and extensible lower level data structures, and relational attributes for data elements. (Source: International Journal of Medical Informatics) - Special issue on Supporting Collaboration in Healthcare Settings: The Role of Informatics
Healthcare is among the most complex and highly collaborative domains of work in the world. Medical informatics researchers have been studying the role of collaboration and how to best support these collaborative activities for a number of years . Furthermore, researchers in disciplines outside of medical informatics such as Computer-Supported Cooperative Work have long been interested in healthcare including examination of electronic medical records in collaborative clinical settings , collaborative technologies in healthcare , and the collaborative practices of patient care teams . Through these and other studies, we have gained a better understanding of the role that collaboration plays in healthcare and the types of technologies that can support collaboration among health care workers.... - Design and implementation of I2Vote– An interactive image-based voting system using windows mobile devices
Conclusion: An easy to use handheld based ARS that enables interactive, image-based, teaching is achieved. The system effectively adds an extra dimension to the use of an ARS. (Source: International Journal of Medical Informatics) - Health information seeking, diet and physical activity: An empirical assessment by medium and critical demographics
Conclusions: In comparison to the Internet, newspaper and television media have more favorable associations with recommended levels of lifestyle behaviors that may be critical in efforts to decrease obesity in the United States. (Source: International Journal of Medical Informatics) - Barriers to acceptance of personal digital assistants for HIV/AIDS data collection in Angola
Conclusions: The findings from this study suggest that personal and cultural beliefs influence participant acceptance of PDAs in Angola. While PDAs provide great advantages in terms of speed and efficiency of data collection, these barriers, if left unaddressed, may lead to biased reporting of HIV/AIDS risk data. An understanding of the barriers and why they are relevant in Angola may help researchers and practitioners to reduce the impact of these barriers on HIV/AIDS data collection. (Source: International Journal of Medical Informatics) - Computerized detection of adverse drug reactions in the medical intensive care unit
Conclusions: Computerized clinical event monitoring systems should be considered when developing methods to detect adverse drug reactions as part of intensive care unit patient safety surveillance systems, since they can automate the detection of these events using signals that have good performance characteristics by processing commonly available laboratory and medication information. (Source: International Journal of Medical Informatics) - The feasibility of an automated monitoring system to improve nurses’ hand hygiene
Conclusion: The results obtained when testing the embedded HH monitoring system demonstrated the feasibility of HH improvement and proved that proposed solution merits a larger and longer clinical trial to measure the degree of improvement and the sustainability of that improvement. (Source: International Journal of Medical Informatics) - Going paperless at the emergency department: A socio-technical study of an information system for patient tracking
Conclusions: ED information systems can have a major impact on organisational practices particularly as new service models of care are gradually introduced in EDs. Considering their spatio-temporal implications while treating the technology as an artifact with transformative, rather than supportive or substitutive, power enhances our understanding of the implementation challenges that need to be addressed during the reshaping of the sociotechnical network. (Source: International Journal of Medical Informatics) - Evaluating the medication process in the context of CPOE use: The significance of working around the system
Conclusion: This study shows how providers are actively involved in working around the interruptions in workflow by bypassing the technology or adapting the work processes. Although certain workarounds help to maintain smooth workflow and/or to ensure patient safety, others may burden providers by necessitating extra time and effort and/or endangering patient safety. It is important that workarounds having a negative nature are recognized and discussed in order to find solutions to mitigate their effects. (Source: International Journal of Medical Informatics) - Using ORA to explore the relationship of nursing unit communication to patient safety and quality outcomes
Conclusion: The results demonstrate the utility of ORA for healthcare research and the relationship of nursing unit communication patterns to patient safety and quality outcomes. (Source: International Journal of Medical Informatics) - Paper persistence, workarounds, and communication breakdowns in computerized consultation management
Conclusion: Understanding these challenges to the current consult management process is important to help design enhanced informatics tools integrated into workflow to support coordination of care and tracking of consults requests. (Source: International Journal of Medical Informatics) - Review of“pull” point-of-care services
We congratulate Strayer and colleagues for publishing a review of clinical information alerting services . They defined alerting services as a service that“pushes” information to clinicians thereby updating them or alerting them to new clinical information . On the opposite, tools where physicians actively search for information in a database of clinical knowledge are “pull” services. In 2010 we published a review of “pull” point-of-care services . Strayer's review and our have similarities and differences. In this letter we quickly point out them. (Source: International Journal of Medical Informatics) - Online health consultation: Examining uses of an interactive cancer communication tool by low-income women with breast cancer
Conclusion: Low-income breast cancer patients sought out information from an online cancer information expert. Patients with more negative perceptions at pre-test tended to use the service more. Greater use of the service was associated with improvement in patients’ perception of health self-efficacy, participation in health care and doctor–patient relationship. Moreover, use of online health consultation appears to level the differences, narrowing the gaps between those who were worse and better off at pre-test. These findings suggest that online healthconsultation can serve as an effective complement to other resources, which help low-income, breast cancer patients feel more confident to participate more actively in their health care, become more actively involved in making decision... - Using electronic medical records to determine the diagnosis of clinical depression
Conclusion: The AUC for“billing diagnosis” of depression performed the best of the three single fields tested, with an AUC of 0.77, corresponding to a test with moderate accuracy. This analysis demonstrates that specific EMR fields can be used as a proxy for PCP assessment of depression for this EMR system. Limitations to our analysis include the physician response rate to our survey as well as the quality of the data, which is collected primarily for administrative and clinical purposes. When using administrative and clinical data in mental health studies, researchers must first assess the accuracy of choosingspecific fields within their EMR system in order to determine the level of accuracy for them to be used as proxies for clinical diagnoses. (Source: International Journal of Med... - Variations in faculty assessment of NICU flowsheet data: Implications for electronic data display
Conclusions: We found that neonatologists who agreed on a diagnosis rarely agreed on the most important data elements that led them to that conclusion. Future studies designed to articulate how physicians decide to direct their attention when presented with flowsheet data may shed light on how this data is utilized and might be optimally presented. (Source: International Journal of Medical Informatics) - Evaluating the success of an emergency response medical information system
Conclusions: The results of the study demonstrate how to evaluate the success of an ERMIS as well as introduce potential changes in how one applies the DeLone and McLean success model in an emergency response medical information system context. (Source: International Journal of Medical Informatics) - Who is NOT likely to access the Internet for health information? Findings from first-time mothers in southwest Sydney, Australia
Conclusions: These findings have important implications for using the Internet for health promotion among young women. A substantial number of first-time mothers do not access the Internet for health information, in particular among those with lower levels of education, lower household income and without a computer at home. (Source: International Journal of Medical Informatics) - Web-based interventions for the management of type 2 diabetes mellitus: A systematic review of recent evidence
Conclusion: The web-based interventions have demonstrated some level of favourable outcomes, provided they are further enhanced with proper e-research strategies. (Source: International Journal of Medical Informatics) - The effect of an interactive e-drug calculations package on nursing students’ drug calculation ability and self-efficacy
Highlights:► Nursing students struggle with performing drug calculations. ► Interactive e-drug calculations package developed based on Cognitive Load Theory. ► E-drug calculations package can be used by learners with different levels of expertise. ► E-package is more effective than handout in improvingdrug calculation ability and self-efficacy. ► Participants were more satisfied using e-package than using handout.Abstract: Objective: Nurses need to be competent and confident in performing drug calculations to ensure patient safety. The purpose of this study is to compare an interactive e-drugcalculations package, developed using Cognitive Load Theory as its theoretical framework, with traditional handout learning support on nursing students’ drug calculation ability, self-ef... - The perception of medical professionals and medical students on the usefulness of an emergency medical card and a continuity of care report in enhancing continuity of care
Conclusions: The EMC and CoC report were found to be useful methods for transporting patient healthcare information across the healthcare continuum. The documents were found more specifically to be useful for effective decision making, improving efficiency and quality of care, at the point of care. (Source: International Journal of Medical Informatics) - Comparing semi-automatic systems for recruitment of patients to clinical trials
Conclusions: System design, scope, and assessment methodology vary significantly between papers, making it difficult to establish the impact of different approaches on recruitment rate. It is clear, however, that the pre-screening phase of trial recruitment is the most effective part of the process to address with CTRSS, that clinical workflow integration and clinician acceptance are critical for this class of decision support, and that the current trends in this field are towards generalization and scalability. (Source: International Journal of Medical Informatics) - Implications of SNOMED CT versioning
Conclusions: In this paper, we have identified four types of changes that occur over time as new SNOMED CT releases are introduced. Keeping track of these changes is important as they are not well published and have an impact in patient case queries and the accuracy of patient records. (Source: International Journal of Medical Informatics) - MEDRank: Using graph-based concept ranking to index biomedical texts
Conclusions: The addition of MEDRank to MTI significantly improved the retrieval of core concepts in MEDLINE abstracts and more closely matched human expectations compared to MTI without MEDRank. In addition, MEDRank slightly improved overall recall and F2. (Source: International Journal of Medical Informatics) - Determination of the effectiveness of two methods for usability evaluation using a CPOE medication ordering system
Conclusions: This study shows that although TA showed a slightly better effectiveness, there is no significant difference between the performance of the CW and the TA methods in terms of number of usability problems identified and the mean severity of these problems. Since no single evaluation method will uncover all of the usability problems a combination of methods is advised as the most appropriate approach, especially if usability problems can lead to potentially fatal outcomes. (Source: International Journal of Medical Informatics) - Ageing-in-place with the use of ambient intelligence technology: Perspectives of older users
Conclusions and implications: Ambient intelligence technologies can contribute to an increased safety and security at home. The technologies alone offer no all encompassing solution as home care and additional environmental interventions are still needed to support ageing-in-place. Results of the study are used to further improve the ambient intelligence technologies and their implementation. (Source: International Journal of Medical Informatics) - Nursing informatics competencies required of nurses in Taiwan
Conclusions: This study provides a current master list of nursing informatics competency requirements for nurses at four levels in the U.S. and Taiwan. The results are very similar to the original work of Staggers et al. The results have international relevance because of the global importance of information technology for the nursing profession. (Source: International Journal of Medical Informatics) - Clinicians satisfaction with CPOE ease of use and effect on clinicians’ workflow, efficiency and medication safety
Conclusions: Users of this CPOE system, which was used for almost a decade, were satisfied with the system's ease of use and its effect on efficiency, workflow and medication safety although the system showed many usability problems and lacked some functionalities. In this case study, therefore, there seems no direct relation between the results of the earlier performed usability evaluation and user satisfaction as determined in the current study. (Source: International Journal of Medical Informatics) - Concept and implementation of a computer-based reminder system to increase completeness in clinical documentation
Abstract: Purpose: Medical documentation is often incomplete. Missing information may impede or bias analysis of study data and can cause delays. In a single source information system, clinical routine documentation and electronic data capture (EDC) systems are connected in the hospital information system (HIS). In this setting, both clinical routine and research would benefit from a higher rate of complete documentation.Methods: We designed a HIS-based reminder system which identifies not yet finalized forms and sends reminder e-mails to responsible physicians depending on escalation level. The generic concept to create reminder e-mail messages consists in database queries on not-finalized forms and generation of e-mail messages based on this output via the communication server. We compar... - Tensions of network security and collaborative work practice: Understanding a single sign-on deployment in a regional hospital
Conclusion: From a preliminary analysis of our on-going field study at a community hospital, there appears to be a number of mismatches between the SSO vision and the realities of routine work. While we cannot conclusively say if a SSO adoption will be effective in meeting its goals in a hospital environment, we do know that it will affect the work practice and that will make the management of the SSO system problematic. (Source: International Journal of Medical Informatics) - Models of information exchange for UK telehealth systems
Conclusion: On comparing the models, three generic models were outlined. Five different forms of information exchange between users of the system were identified: patient-push, system-stimulation, dialogue, health professional-pull and observation. Patient-push and health professional-pull are the dominant themes from the telehealth offerings evaluated. (Source: International Journal of Medical Informatics) - Multi-disciplinary collaboration during ward rounds: Embodied aspects of electronic medical record usage
Conclusions: We conclude with a discussion on the effects of electronic medical records on multi-disciplinary interaction and suggest a number of implications for their design: including, considering the social ergonomics of the device, the inclusion of paper in electronic medical records, addressing data fixation, and facilitating practitioners to make social changes to the interaction through the ability to make technical changes to the system. (Source: International Journal of Medical Informatics) - Coping with the unforeseen in surgical work
Discussion: We used the concept of high-reliability organisations as proposed by Weick and Sutcliffe, 2007 , to analyse the observed coping strategies. The coping strategies can be seen as examples of the principles for managing the unexpected that Weick and Sutcliffe propose. IT support for this must include both awareness-creating systems and systems that enable workers to control the effects of unforeseen events once they have occurred. (Source: International Journal of Medical Informatics) - Hospital readiness for health information exchange: Development of metrics associated with successful collaboration for quality improvement
Research highlights:► Organizational leadership is important to data-sharing efforts across hospital organizations. ► We developed and tested a reliable measure for quality improvement (QI) Leadership. ► This measure was associated with successful participation in data-sharing collaboratives. ► Such measures can contribute to the development of data-sharing readiness metrics.Abstract: Objective: The development of readiness metrics for organizational participation in health information exchange is critical for monitoring progress toward, and achievement of, successful inter-organizational collaboration. In preparation for the development of a tool to measure readiness for data-sharing, we tested whether organizational capacities known to be related to readiness were associated wit... - Organizational routines, innovation, and flexibility: The application of narrative networks to dynamic workflow
Discussion: Narrative networks are a means for analyzing and visualizing organizational routines in concert with more traditional requirements engineering, workflow modeling, and quality improvement outcome measurement. This type of analysis can support a deeper and more nuanced understanding of how and why certain routines continue to exist, change, or stop entirely. At the same time, it can illuminate areas in which adoption may be slow, more training or communication may be needed, and routines preferred by the leadership are subverted by routines preferred by the staff. (Source: International Journal of Medical Informatics) - Collaboration in electronic medical evidence development: A case study of the Social Security Administration's MEGAHIT System
Conclusions: Multi-party collaboration can result in technical success, but achieving that success is dependent on a variety of organizational factors. This case study highlights the significance of and potential for requesting and receiving patient health information across the NwHIN. It will inform interested collaborating stakeholders as SSA engages additional providers in using MEGAHIT to collect health information via the NwHIN. (Source: International Journal of Medical Informatics) - LERM (Logical Elements Rule Method): A method for assessing and formalizing clinical rules for decision support
Conclusions: A method is presented to assist in assessing clinical rules for their amenability to decision support, and formalizing the rules for implementation. Validation shows that the method is usable and reliable between users. Use of a terminology increases reliability but also the error rate. The method is useful for future developers of systems which offer decision support based on clinical rules. (Source: International Journal of Medical Informatics) - A model of awareness to enhance our understanding of interprofessional collaborative care delivery and health information system design to support it
Conclusion: Awareness is a complex yet crucial piece of successful ICC. The information sources that provided and supported ICC awareness were varied. The different types of awareness from the model can help us understand the explicit details of how care providers communicate and exchange information with one another. Increased understanding of ICC awareness can assist with the design and evaluation of HISs to support collaborative activities. (Source: International Journal of Medical Informatics) - Disrupted rhythms and mobile ICT in a surgical department
Conclusions: Mobile ICT tools may break down informal communication and coordination structures. This may reduce the efficiency of the new tools, or contribute to resistance towards such systems. In some situations however such“disrupted rhythms” may be overcome by including additional sociotechnical mechanisms in the overall design to counteract this negative side-effect. (Source: International Journal of Medical Informatics) - Leadership structures in emergency care settings: A study of two trauma centers
Conclusion: Most important weaknesses of different leadership structures are manifested in inefficient teamwork or inappropriate patient care. These inefficiencies are particularly problematic when leadership is shared between physicians from different disciplines with different levels of experience, which often leads to conflict, reduces teamwork efficiency and lowers the quality of care. We discuss practical implications for technology design. (Source: International Journal of Medical Informatics) - An exploration of the impact of computerized patient documentation on clinical collaboration
Conclusions: This study demonstrates how socio-technical systems co-evolve to support essential human function of coordination and collaboration. Users adapted the system in unique and useful ways that provide insight to future development. (Source: International Journal of Medical Informatics) - Electre Tri-C, a multiple criteria decision aiding sorting model applied to assisted reproduction
Research highlights:▶ A multiple criteria decision support tool for assisted reproduction (ART). ▶ A new way for taking into account the preferences of ART medical experts. ▶ Intuitive tool, well-accepted by ART medical experts.Abstract: Objective: The aim of this paper is to apply an informatics tool for dealingwith a medical decision aiding problem to help infertile couples to become parents, when using assisted reproduction.Methods: A multiple criteria decision aiding method for sorting or ordinal classification problems, called Electre Tri-C, was chosen in order to assign each couple to an embryo-transfer category. The set of categories puts in evidence a way for increasing the single pregnancy rate, while minimizing multiple pregnancies. The decision aiding sorting model was c... - Electromagnetic interference of magnetic field based auto identification technologies in healthcare settings
Conclusion: A low frequency, magnetic field based wireless autoidentification technology induced distance dependent EMI in healthcare settings, making implementation potentially safe at antenna distances greater than 4 feet from clinical equipment. However, implementation requires rigorous in vivo testing to ensure the antenna is located a safe distance away. (Source: International Journal of Medical Informatics) - The changes in caregivers’ perceptions about the quality of information and benefits of nursing documentation associated with the introduction of an electronic documentation system in a nursing home
Conclusions: The electronic documentation system was perceived to perform better than the paper-based system in some aspects, with subsequent benefits to management of aged care services. In other areas, perceptions of additional benefits from the electronic documentation system were not maintained. In a number of attributes, there were similar perceptions on the two types of systems. (Source: International Journal of Medical Informatics) - The use of conferencing technologies to support drug policy group knowledge exchange processes: An action case approach
Conclusions: This study highlights lessons related to the use of conferencing technologies to support distant knowledge exchange within drug policy groups. Key lessons from this study can be used by drug policy groups to support successful knowledge exchange activities using conferencing technologies. (Source: International Journal of Medical Informatics) - The role of standardized data and terminological systems in computerized clinical decision support systems: Literature review and survey
Conclusion: Many CDSSs applied different terminological systems to code data. This diversity hampers the possibility of sharing and reasoning with data within different systems. The results of the survey confirm the hypothesis that data standardization is a critical success factor for CDSS development. (Source: International Journal of Medical Informatics) - Views on health information sharing and privacy from primary care practices using electronic medical records
Abstract: Objective: To determine how patients and physicians balance the perceived benefits and harms of sharing electronic health data for patient care and for secondary purposes.Design: Before-after survey of patients and providers in practices using electronic medical records (EMRs) enrolled in a clinical trial in Ontario, Canada.Measurements: Outcomes were measured using the Health Information Privacy Questionnaire (HIPQ) at baseline and end of study. Thirteen questions in 4 general domains investigated attitudes towards the privacy of EMRs, outsider's use of patient's health information, the sharing of patient's information within the health care system, and the overall perception of benefits versus harms of computerization in health care.Results: 511 patients (mean age 60.3 years, 4... - The IT productivity paradox in health: A stakeholder's perspective
Conclusions: An assessment framework was developed to provide general guidance on how to assess HIT impacts. The proposed framework will be useful for researchers and practitioners as it takes into account the underlying reasons for the HIT productivity paradox and identifies the salient outcomes of interest linked to HIT implementation. (Source: International Journal of Medical Informatics) - The integration of Information and Communication Technology into nursing
Conclusion: The emerging world of the‘integrated nurse’ cannot be adequately understood without examining how nurses make use of ICT and the Internet within nursing practice and the way this is shaped by institutional, technical and professional opportunities and constraints. (Source: International Journal of Medical Informatics) - Design and implementation of a seamless and comprehensive integrated medical device interface system for outpatient electronic medical records in a general hospital
Conclusion: The current implementation of the medical device interface system based on the SMC framework significantly streamlines the clinical workflow in a satisfactory manner. (Source: International Journal of Medical Informatics) - An exploratory study of a text classification framework for Internet-based surveillance of emerging epidemics
Conclusions: The proposed text classification framework utilizing randomly sampled unlabeled articles can facilitate a cost-effective approach to training machine learning classifiers in a real-life Internet-based biosurveillance project. We plan to examine this framework further using larger data sets and using articles in non-English languages. (Source: International Journal of Medical Informatics) - Exploring practice variation in preventive pressure-ulcer care using data from a clinical data repository
Conclusion: A standardized nursing-terminology-based electronic nursing record system allowed us to monitor the variations in nursing practice with regard to preventive pressure-ulcer care in intensive-care patients with and at risk of pressure ulcers. We found that pressure-ulcer prevention care was provided at frequencies much lower than the recommended guidelines. Further studies on identifying the factors affecting pressure-ulcer prevention care and ways to improve the quality of that care are needed. (Source: International Journal of Medical Informatics) - Perceptions of e-prescribing efficiencies and inefficiencies in ambulatory care
We report on qualitative date from 64 focus groups with clinicians and office staff from six US states. Participants used one of six e-prescribing software packages. Qualitative data from the focus groups (276 participants) were coded and analyzed using NVivo software. Quantitative data regarding perceived efficiencies were extracted from a survey of 157 clinicians using e-prescribing.Results: Perceptions of e-prescribing included 64% reporting e-prescribing as very efficient. The next closest method was computer generated fax and prescriptions in which∼25% rated the method as very efficient. Improvements in workflow and record keeping were noted. Perceived efficiencies were realized by decreased errors, availability of formularies at the point of prescribing and refill processing. Perc... - A comprehensive RFID solution to enhance inpatient medication safety
Abstract: Errors involving medication administration can be costly, both in financial and in human terms. Indeed, there is much potential for errors due to the complexity of the medication administration process. Nurses are often singled out as the only responsible of these errors because they are in charge of drug administration. Nevertheless, the interventions of every actor involved in the process and the system design itself contribute to errors (Wakefield et al. (1998) ). Proper inpatient medication safety systems can help to reduce such errors in hospitals. In this paper, we review in depth two recent proposals (Chien et al. (2010) ; Huang and Ku (2009) ) that pursue the aforementioned objective. Unfortunately, they fail in their attempt mainly due to their security faults but intere... - Factors that influence public engagement with eHealth: A literature review
Conclusions: Recommendations for policy makers, developers, users and health professionals, include: targeting efforts towards those underserved by eHealth; improving access; tailoring services to meet the needs of a broader range of users; exploiting opportunities for social computing; and clarifying of the role of health professionals in endorsement, promotion and facilitation. (Source: International Journal of Medical Informatics) - Detection of pneumonia using free-text radiology reports in the BioSense system
Conclusion: Empirical methods may assist in finding radiology report keywords that are most highly predictive of a pneumonia diagnosis. (Source: International Journal of Medical Informatics) - Determining the privacy policy deficiencies of health ICT applications through semi-formal modelling
Abstract: To ensure that patient confidentiality is securely maintained, health ICT applications that contain sensitive personal information demand comprehensive privacy policies. Determining the adequacy of these policies to meet legal conformity together with clinical users and patient expectation is demanding in practice. Organisations and agencies looking to analyse their Privacy and Security policies can benefit from guidance provided by outside entities such as the Privacy Office of their State or Government together with law firms and ICT specialists. The advice given is not uniform and often open to different interpretations. Of greater concern is the possibility of overlooking any important aspects that later result in a data breach. Based on three case studies, this paper conside... - The recommendations from the 2009 SiHIS working conference in Hiroshima—Issues on trustworthiness of health information and patient safety
Abstract: Held on 21st to 23rd November 2009 in Hiroshima, the SiHIS working conference aimed at finding solutions to approach to an idealistic society where (1) the individual can trust information with full understanding and responsibility, (2) the individual can allow the use of information backed by sound legitimated environment, (3) information can play its role for better healthcare and the improvement of medicine. The purpose of this paper is to propose recommendations from this working conference. (Source: International Journal of Medical Informatics) - Designing for collaborative interpretation in telemonitoring: Re-introducing patients as diagnostic agents
Conclusion: Telemonitoring practices of patients with ICDs involve three entangled collaborative processes, whereas the existing socio-technical setup only mediate one. myRecord is designed as an add-on collaborative technology to mediate the two remaining collaborative processes. We argue that myRecord solves some of the problems with ICD data interpretation inherent in telemonitoring practices by providing a collaborative, asynchronous space for healthcare practitioners and patients to mediate the two processes that are otherwise lost. Our new socio-technical design also transforms the role of patients considerably, thus new studies should take these insights into consideration. (Source: International Journal of Medical Informatics) - Ethical and legal challenges for health telematics in a global world: Telehealth and the technological imperative
Abstract: Telehealth is one of the more recent applications of ICT to health care. It promises to be both cost-effective and efficient. However, there lies a danger that focusing mainly on pragmatic considerations will ignore fundamental ethical issues with legal implications that could undermine its success. Implicated here are, among others, changes in the nature of the health care professional patient relationship and informed consent, etc. The position of health informatics professionals as well as hard- and software providers is also affected. A further complicating factor is outsourcing. This paper identifies relevant issues and outlines some of their implications. (Source: International Journal of Medical Informatics) - Application of data mining to the identification of critical factors in patient falls using a web-based reporting system
Conclusion: In addition to medication use such as anti-psychotic and diuretics, nursing intervention where a fall assessment is conducted could represent a critical factor related to outcomes of fall incidence. (Source: International Journal of Medical Informatics) - Effect of a nursing information system on the quality of information processing in nursing: An evaluation study using the HIS-monitor instrument
Conclusions: The HIS-monitor was found to be a useful instrument, in turn showing that the quality of the information processing in nursing strongly increased after the introduction of a nursing information system. (Source: International Journal of Medical Informatics) - Medical record search engines, using pseudonymised patient identity: An alternative to centralised medical records
Conclusions: Faced with the difficulties and the risks of setting up a centralised medical record system, a system that gathers all of the available information concerning a patient could be of great interest. This low-cost pragmatic alternative which could be developed quickly should be taken into consideration by health authorities. (Source: International Journal of Medical Informatics) - Detection of bed-exit events using a new wireless bed monitoring assistance
Conclusion: In this small feasibility study, Heasys® seemed to be an effective innovative device allowing bed-exit events detection in adult patients and healthy volunteers. (Source: International Journal of Medical Informatics) - The impact of medical record technologies on collaboration in emergency medicine
Conclusions: An analysis of work practice across the two hospitals revealed the role of medical records in facilitating or hindering the coordination of time sensitive and context dependent distributed work, as well as the specific influence of EMR. Recognizing that work practice compensates for the limitations of technology, we suggest four requirements for the design of EMR to promote workplace efficiency: facilitation of locally customized data presentations; support for integration of hitherto fragmented record systems and data formats; support for effective multi-user coordination of control tasks; and guidance for standardizing a level of detail in planning and documenting care. (Source: International Journal of Medical Informatics) - Aspects of privacy for electronic health records
Abstract: Patients’ medical data have been originally generated and maintained by health professionals in several independent electronic health records (EHRs). Centralized electronic health records accumulate medical data of patients to improve their availability and completeness; EHRs are not tied to a single medical institution anymore. Nowadays enterprises with the capacity and knowledge to maintain this kind of databases offer the services of maintaining EHRs and adding personal health data by the patients. These enterprises get access on the patients’ medical data and act as a main point for collectingand disclosing personal data to third parties, e.g. among others doctors, healthcare service providers and drug stores. Existing systems like Microsoft HealthVault and Google Health... - Ontology driven health information systems architectures enable pHealth for empowered patients
Abstract: The paradigm shift from organization-centered to managed care and on to personal health settings increases specialization and distribution of actors and services related to the health of patients or even citizens before becoming patients. As a consequence, extended communication and cooperation is required between all principals involved in health services such as persons, organizations, devices, systems, applications, and components. Personal health (pHealth) environments range over many disciplines, where domain experts present their knowledge by using domain-specific terminologies and ontologies. Therefore, the mapping of domain ontologies is inevitable for ensuring interoperability. The paper introduces the care paradigms and the related requirements as well as an architectur... - Special Issue Call for Papers: Designing for Healthy Living
(Source: International Journal of Medical Informatics) - eHealth in Belgium, a new“secure” federal network: Role of patients, health professions and social security services
Abstract: eHealth platform is the official federal network in Belgium (created by law on 21 August 2008) devoted to a secure exchange of health data in many types of applications, such as health care purposes, simplification of administrative procedures and contribution to health policy. It implies a controlled access to decentralized databases and uses encrypted personal data. The national identification number has been chosen in order to authenticate the requester, the patient, and the receiver of information exchange. Authorizations have to be respected in order to obtain personal health data.Several questions are raised about its security: the lack of mandatory request for systematic journaling on accesses to the electronic patient record as well as the absence of explicit procedures f... - Model development for EHR interdisciplinary information exchange of ICU common goals
Conclusion: The model suggests that EHRs should support: (1) information tools for the explicit documentation of goals, interventions, and assessments with synthesized and summarized information outputs of events and updates; and (2) messaging tools that support collaborative decision-making and patient safety double checks that currently occur between nurses and physicians in the absence of EHR support. (Source: International Journal of Medical Informatics) - Perceived efficiency impacts following electronic health record implementation: An exploratory study of an urban community health center network
Conclusions: These findings suggest that CHCs face difficult and often unique barriers related to EHR implementation and use, and the resultant efficiency impacts should not be overlooked. (Source: International Journal of Medical Informatics) - The MITRE Identification Scrubber Toolkit: Design, training, and assessment
Conclusions: The MIST toolkit makes possible the rapid tailoring of automated de-identification to particular document types and supports the transition of the de-identification software to medical end users, avoiding the need for developers to have access to original medical records. We are making the MIST toolkit available under an open source license to encourage its application to diverse data sets at multiple institutions. (Source: International Journal of Medical Informatics) - Misspellings in drug information system queries: Characteristics of drug name spelling errors and strategies for their prevention
Conclusion: Drug information systems should be equipped with error-tolerant algorithms to reduce search failures. Drug initial letters are also error-prone, thus auto-completion is not a sufficient error-prevention strategy and needs additional support by error-tolerant algorithms. (Source: International Journal of Medical Informatics) - The introduction of a diagnostic decision support system (DXplain™) into the workflow of a teaching hospital service can decrease the cost of service for diagnostically challenging Diagnostic Related Groups (DRGs)
Conclusions: Using DXplain on all diagnostically challenging cases might save our medical center over $2,000,000 a year on the General Medicine Services alone. Using clinical diagnostic decision support systems may improve quality and decrease cost substantially at teaching hospitals. (Source: International Journal of Medical Informatics) - Updating clinical knowledge: An evaluation of current information alerting services
Conclusions: We developed a checklist that can be used to reliably assess the quality of clinical information updating tools. We found many shortcomings in currently available clinical knowledge updating tools. Ideally, these tools will evolve in the direction of applying basic evidence-based medicine principles to new medical information in order to increase their usefulness to clinicians. (Source: International Journal of Medical Informatics)